Fertility Questions

Dear Dr. Brown,

Thank you for providing this service!  I feel like women's health issues are enshrouded in mystery, and it is amazing that an expert like you is willing to disseminate quality information.  I have a few questions about my own fertility and reproductive health.  

1.) I am a 25 year old female.  I have not yet had vaginal sex, but I had one oral/mutual masturbation encounter over a year ago with a male my age (I gave with protection, received without).  I learned later of his promiscuity, and was nervous enough to get STD tested around 11 months later.  The nucleic acid test on my urine was positive for a low grade chlamydia infection.  My doctor treated me with a single dose of azithromycin.  I have been anxious about my fertility since.  Could the bacteria move from his mouth/hands, through my hymen and up my vagina into my reproductive organs? My doctor said it is unlikely that I had chlamydia without having sex, but that it is possible I contracted it from the oral encounter.  How likely is it that I had chlamydia?  I would have had it for 11 months!  Could I have incurred significant reproductive damage?  I am now very conscious of any lower abdominal discomfort. But would I start getting symptoms months after treatment? We have other organ systems that could cause occasional twinges of lower abdominal discomfort, correct (digestive perhaps)?  Also, the test was a low positive.  Does that mean I might not have had it (without being a false positive)?
2) I've never had a pap smear.  Are there any reasons I should be getting them even though I haven't had sex?  
3) My mom had fibroids and a hysterectomy (though no other woman in my family has).  Am I at a higher risk for them?
4) I was also wondering what the research indicates about having children later in life, and whether fertility treatments have been correlated with increased incidences of disabilities in kids.

Thank you again for your help and expertise!  It is greatly appreciated.

[Elaine Brown, MD]

Hi!
If you came in to my office for consultation I would most likely tell you the following:

It seems awfully unlikely that you would have contracted Chlamydia from the encounter your describe, and I would suspect a false positive test--up to 20% chance depending upon several variables.  If you did have asymptomatic chlamydia, your doctor gave you the proper therapy for it.  My bet is that your discomfort is caused by bowel rather than reproductive organs, but would need more history and an exam of course.

I believe that paps are recommended for all women over age 21, although personally, I usually defer them for virginal patients due to an extremely low incidence of hpv related problems.


There may be a hereditary component to fibroids, so I would follow you closely with exams and ultrasound if necessary.

Fertility declines with age, and the risk of chromosomal abnormalities increases (eg Down's syndrome).  Fertility treatments don't cause disabilities--and there is no increase in incidence over baseline.

Finally, if you were "trying" at this point, I might suggest a test for chlamydia antibodies and an HSG (hysterosalpingogram--checks for tubal damage) if you were not having success after 6-12 months of unprotected intercourse.

Hope this helps!
Dr B

[FertilityFears]

Dear Dr. Brown,

Thank you for your response!  I am a little confused by the 20% chance.  Is it a 20% chance that I contracted chlamydia or a 20% chance that it was a false positive?  What are the factors or variables that influence that probability? I'm not going to be trying to have children for a very long time, I have academic and career passions I want to satisfy first.  But I will eventually want a family, and I'm terrified that this isolated sexual experience has left me with fertility problems.  It sounds like it is a possibility.  Is there any way that I can verify whether I was infected so that I don't have to worry about it for several years into the future?  Could I take the test for chlamydia antibodies now?  

Thank you for your help and your knowledge!